My Lords, I should make it clear that I will not move the second Motion in this group on the National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations. The Joint Committee on Statutory Instruments has drawn it to the special attention of the House, and the House, rightly, will need time to consider its report. I shall speak to the two remaining Motions standing in my name on the Order Paper: the Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019 and the Social Security Coordination (Reciprocal Healthcare) (Amendment etc.) (EU Exit) Regulations 2019.

The Government are bringing forward these two statutory instruments under Section 8 of the European Union (Withdrawal) Act 2018, to correct deficiencies in retained EU law relating to reciprocal and cross-border healthcare, and to ensure that the law is operable on exit day. When the UK leaves the EU, that Act will automatically retain the relevant EU legislation and the domestic implementing legislation in UK law. However, in the event of no deal, and if we do not legislate further, the regulations would be incoherent or unworkable without reciprocity from member states. If we did nothing there might also be a lack of clarity regarding patients’ rights to UK-funded healthcare in the EU.

Current EU reciprocal healthcare arrangements enable people to access healthcare when they live, study, work, or travel in the EU/EEA and Switzerland, and vice versa in the UK. These arrangements give people retiring abroad more security. They support tourism and businesses, and facilitate healthcare co-operation. The UK funds healthcare abroad for a number of current or former UK residents. This includes 180,000 pensioners and their dependents in the EU. We also fund needs-arising healthcare in the EU/EEA and Switzerland for UK tourists and students. There are 27 million EHIC cards in circulation in the UK, which results in around 250,000 claims each year. We directly fund healthcare for 10,000 posted workers and their dependents in the EU/EEA and Switzerland. We also fund around 1,350 UK residents each year to travel overseas to receive planned treatment in the EU/EEA and Switzerland. Finally, around 1,100 people from England and Wales access healthcare through the cross-border healthcare directive route.

The Government’s intention is to continue these reciprocal healthcare arrangements with countries in any exit scenario—deal or no deal—as they exist now, until 31 December 2020. In a deal scenario, the in-principle agreement we have reached with the EU, the EEA and Switzerland is that during the implementation period—that is, until 31 December 2020—all reciprocal and cross-border healthcare entitlements will continue and there will be no changes to healthcare for UK pensioners, workers, students, tourists and other visitors, to the EHIC scheme, or regarding planned treatment.

The Government want to secure a wider reciprocal healthcare agreement with the EU/EEA and Switzerland following the end of the implementation period that will support a broad range of people when they move between the UK and the EU/EEA and Switzerland for leisure, study or work. In a no-deal scenario, our offer to all member states is to maintain the current reciprocal healthcare arrangements for at least a transitional period to ensure that people living in, working in or visiting our respective countries can continue to access affordable healthcare.

The statutory instruments we are considering will support us in maintaining current reciprocal healthcare arrangements for countries with which we have agreed reciprocity for a transitional period lasting until 31 December 2020, and to remove these arrangements in the longer term. The transitional arrangements would not apply to countries that do not agree to maintain the current reciprocal arrangements. Continuing the current arrangements is possible only with the agreement of other member states, and we are in advanced discussions on this issue. We have approached other member states and are prioritising the major pensioner, worker and tourist destinations.

The UK and Irish Governments are committed to continuing access to healthcare services within the common travel area, and both Governments are taking legislative steps to enable us to implement these arrangements by exit day. The two instruments that we are considering are our implementing mechanism. We also welcome the action by those EU member states that have prepared their own legislation for a no-deal scenario, including, but not limited to, Spain, France, Portugal, and Belgium. However, depending on decisions by member states, it is important to acknowledge that people’s access to healthcare could change. Naturally there is concern about what this will mean and what should be done. This is an uncertain situation and I appreciate that that may be difficult for people. I hope I can be reassuring.

All of the 27 EU member states are countries with universal healthcare coverage, and in general people have good options for obtaining healthcare, provided that they take the appropriate steps. After exit, should there be no bilateral arrangements in place, the Majority of UK nationals who currently live or work in the EU will still have good options for accessing healthcare. Depending on the country, it will generally be possible for people to access healthcare through legal residency, current or previous employment, or joining a social insurance scheme and contributing a percentage of their income, as other residents need to do. Less frequently, people may need to purchase private insurance. When people travel overseas they should purchase travel insurance, as we already encourage everyone to do. However, I appreciate that this can be difficult for people with long-term conditions, and it is important that people make the best decisions for their circumstances when choosing to travel.

As is the case now, UK nationals who return to live permanently in the UK will be able to access NHS care. If these people return to live in the UK part-way through their treatment, they will be treated by the NHS fairly and equitably. UK nationals who have their healthcare funded by the UK under current EU arrangements and are resident in the EU on exit day can use NHS services in England without charge when they temporarily visit England.

We recognise that this means change, and in some circumstances additional expense, for UK nationals living abroad. It is to avoid this that we are bringing forward these statutory instruments. I would like to reassure noble Lords that the Government have issued advice, via government and NHS websites, to UK nationals living in the EU, to UK residents travelling to the EU/EEA and Switzerland, and to EU nationals living in the UK. This advice explains how the UK is working to maintain reciprocal healthcare arrangements, but that their continuation depends on decisions by member states. It also sets out what options people might have to access healthcare under local Laws in the member state they live in if we do not have bilateral arrangements in place, and what people can do to prepare. However, in some circumstances, these instruments will protect individuals irrespective of reciprocity with other countries. That issue was raised by the noble Baroness, Lady Thornton, during the Third Reading of the Healthcare (International Arrangements) Bill. I take this opportunity to reassure her again.

Through these instruments, we can finish funding healthcare for people in a transitional situation. To be clear, this would cover people in the middle of treatment on exit day, those who have already had treatment and those who have applied for, or been given authorisation for, treatment before exit day. This would apply for a year or the period of authorisation, whichever is later. Of course, that assumes that the state is willing to provide treatment and accept reimbursement from the UK. Through these instruments, the Government are offering to continue to fund healthcare through the current reciprocal healthcare and cross-border healthcare arrangements until 31 December 2020 in the member states that agree to reciprocate. It is not feasible to fund directly healthcare for hundreds of thousands of people living in or visiting the EU without the co-operation of member states.

Noble Lords will know that the Government have also brought forward a Bill focused on reciprocal healthcare arrangements—the Healthcare (International Arrangements) Bill—which is an important means for implementing reciprocal healthcare arrangements. This Bill will ensure that the UK can respond to all possible exit scenarios, and complements the approach we are taking with these instruments. It provides powers to give effect to comprehensive healthcare arrangements that are bespoke or different in any way to the current arrangements provided by the EU regulations. It also provides a legislative framework to implement longer-term, complex reciprocal healthcare arrangements with the EU, or bilateral agreements with individual member states.

We are also exploring whether there is a need to fund further healthcare for limited numbers of people in exceptional circumstances where there would otherwise be a serious risk to their health. The Bill will give us the powers to do that and to respond to an unpredictable situation. Clearly, we need to prioritise support for individuals who need it most in countries where there are challenges in obtaining healthcare; it is our hope that it will not be necessary at all. We need to be clear on the outcome of bilateral arrangements and the needs of specific groups before setting out the policy. I recognise the difficulty of the current situation and want to assure people that we are doing all we can to minimise the changes in the way care is accessed.

I should clarify before I close that the instruments we are considering do not make changes to welfare benefits policy. The Department for Work and Pensions is bringing forward separate legislation on welfare benefits. I assure noble Lords that we have been working closely with our colleagues in the devolved Administrations, who have provided consent for these instruments. In the absence of a Northern Ireland Executive, we are also taking forward today, on behalf of Northern Ireland, amendments to the legislation that implemented the cross-border healthcare directive in Northern Ireland.

In conclusion, I want to make it clear that these instruments make miscellaneous amendments to EU references in retained EU law, such as removing references to EU concepts. Moreover, the Bill and these instruments are necessary legislative vehicles to ensure that the UK Government are ready to deal with reciprocal and cross-border healthcare in any EU exit scenario. These instruments provide us with an effective mechanism to ensure that there is no interruption to people’s healthcare in a no-deal situation. I know that I have spoken for a long time but I felt that it was important to set out this issue clearly for the House. I beg to move.